Serial phospholipid analysis in preterm infants: Comparison of Exosurf andSurvanta

The initial clinical response to synthetic or natural surfactant is differe nt and long-term complications from meta-analysis suggest that bronchopulmo nary dysplasia and retinopathy of prematurity may be increased in infants g iven synthetic surfactant. It is possible that this is due to differences i n the phospholipid composition of lung fluid following administration of th ese surfactants. Infants less than 32 weeks gestation with respiratory dist ress syndrome (RDS) were randomly assigned to receive either Exosurf, an ar tificial surfactant, or Survanta, a natural surfactant. Endotracheal or hyp opharyngeal aspirates were obtained from these infants and from control inf ants who had normal lungs. The aspirates were taken prior to and up to 28 d ays following surfactant administration. The different phospholipids were s eparated by thin layer chromatography and expressed as a percent of total p hospholipid measured. Infants with normal lungs had a higher proportion of phosphatidylcholine than those with RDS prior to treatment. The infants wit h normal lungs had a greater proportion of phosphatidylinositol in their lu ng aspirates than both treatment groups at 24 h. Infants in the Survanta gr oup had a higher proportion of phosphatidylglycerol at 48 h than the group with normal lungs. No other differences were found in phospholipid composit ion up to 28 days. There were no major differences in the phospholipid prof ile in infants with RDS treated with either Exosurf or Survanta. In conclus ion, neither the clinical differences initially seen between infants treate d with either Exosurf or Survanta, nor the long-term outcome could be expla ined by the phospholipid composition of serial samples of lung aspirates. ( C) 1999 Elsevier Science Ireland Ltd. All rights reserved.